Physician perspectives on advanced directive discussions: An examination of perceived benefits and barriers

It is estimated that only about 18% of Americans have completed any type of advance directive (Fagerlin, Ditto, Schneider & Smucker, 2002), yet it has been over 20 years since the passage of the Patient Self-Determination Act of 1990, which requires healthcare facilities who receive Medicaid and Medicare funding to educate patients about advance directives (Hahn, 2003). This study sought to understand physician roles in discussions related to advance directives with patients. Using a qualitative research design, the study investigates physicians' attitudes, justifications and discomfort regarding advance directive discussions. A number of projects have concentrated on end-of-life issues; however, none could be found that directly presented physician perspectives--their voices.

For this project, phenomenology was employed to analyze data. Participants were randomly selected. In one instance, they were asked to recall previous knowledge about cases where they presented patients with advance directive discussions. Lastly, they were presented with vignettes to simulate new phenomena where the natural attitude (existing knowledge from previous cases) could be compared and contrasted to the phenomenological attitude (the use of vignettes).

Some of the major findings were: Health trumped age in terms of when physicians initiated advance directive discussions with patients; physicians placed the responsibility for the initiation of advance directive discussions on patients—“Its not my responsibility”. As these variables were not considered in this project, future research should examine physicians by race, age and sex as predictors of when advance directive discussions might be initiated.